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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An analysis was conducted on the pediatric admissions of children 12 years of age, and morbidity and mortality from Lok Nayak Jai Prakash Narayan Hospital, Delhi, India for the periods of 1955-58, 1965-68, 1974-77, 1984-87. The hospital is attached to a medical school and has a 1980s pediatric bed strength of 150. The population using this facility was low or middle income. Admission for pediatric surgery, orthopedic, ear-nose-throats, or other specialities were not included. Pediatric admissions from the 1st period to the present period increased by 3 times to 31, 187. The total hospital admissions over the 22 years from block periods 1965-1987 only showed a 1.5 times rise in the admission rate. Pediatric admissions were 11.6% , 167.7%, and 18.4% of total hospital admissions for 1965-68, 1974-77, and 1984-87 respectively. When nursery admissions are excluded, admissions were stable at 12%. The commonest cause of admissions was diarrheal disorders, followed by pneumonia. The Indian population consists of a 40% pediatric age group and almost 50% of total mortality occurs in this age group. The increase in pediatric admissions is understood to be reflective of a growing awareness of child health. Pediatric mortality has declined from 15.6% in 1965-68 to 11% in the mid 1970s and 10.8% in 1984-87. When neonatal mortality has been excluded from pediatric mortality, there has also been a decline and stabilization since 1955 at 13.1%. A primary concern is deaths from tetanus. 20.8% in 1974-77 and 13.6% in 1984-87 of neonatal deaths were due to preventable tetanus infections. 60% of the admissions in 1984-87 were for tetanus and resulted in 87.9% of deaths. This hospital center acts as a referral center for tetanus. Epidemics have affected the rates of pyogenic meningitis and encephalitis. Community awareness of disease also affects admissions. Mortality from diarrheal disorders has declined significantly from 19.7% in 1955-58 to 8.2% in 1974-77 and stabilized due to newer diagnostic and treatment procedures such as oral rehydration therapy and public awareness.
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PMID:Childhood morbidity and mortality in a large hospital over last four decades. 193

Diarrhea, pneumonia, and malnutrition account for most of mortality and morbidity in children in developing countries. The Expanded Program of Immunization (EPI) is making progress with more than 50% of children under the age of 1 year receiving vaccination against the 6 EPI-listed diseases. The eradication of poliomyelitis by 2000 is realistic, so that the world could be smallpox- and polio-free by the 21st century. In July-August 1988 a cholera epidemic erupted in Delhi, India in which several hundreds died. The combined whole cell and toxin-B subunit oral vaccine against cholera has shown a decrease in protection from around 75-80% at the end of 6 months to around 60% at the end of 2 years. Typhoid fever affecting close to 8 million people in Asia has been treated with the improved formulation of TY21A vaccine and with the Vi polysaccharide capsular surface antigen in encouraging trials in Nepal. Co-trimoxazole has reduced child mortality caused by acute lower respiratory tract infections at the community level. 3 oral antirabies vaccines have been found safe, and oral baits have been effective. Chloroquine-resistant Plasmodium falciparum malaria is a major problem in may Asian countries involving sulfadoxine-pyrimethamine combinations as well. Lymphatic filariasis is expressed clinically as elephantiasis. More than 90 million people are believed to be infected. Ivermectin in a single dose as low as 25 mcg/kg of body weight was shown to be microfilaricidal in lymphatic filariasis. Allopurinol riboside is effective against visceral leishmaniasis or kala-azar. Leprosy and tuberculosis continue to be major health problems in Asia. There have been encouraging advances in immunization against cancers of the tropics, such as hepatitis B and primary carcinoma of the liver, the human papilloma virus and cancer of the uterine cervix, the Epstein-Barr virus and Burkitt's lymphoma, and nasopharyngeal carcinoma.
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PMID:Perspectives on research and diseases of the Tropics: an Asian view. 269 93

A prospective study was conducted to determine the safety and efficacy of cholecystectomy through a 5 cm transverse abdominal incision. 181 consecutive patients who underwent elective cholecystectomy for symptomatic gall stone disease in a single surgical unit at the All India Institute of Medical Sciences, New Delhi between December 1990 to February 1992, were prospectively randomized into 5 cm transverse and midline incision groups. Operative time, blood loss, post-operative stay and complications were compared in the two groups. Ninety seven patients were included in the transverse incision group and 84 patients in the midline group. Cholecystectomy could be safely performed through a 5 cm transverse incision in 84 patients (86.8%) without increase in operative complications, morbidity or mortality. In another 84 patients cholecystectomy was performed through a midline incision. The average operating time and blood loss were comparable in both groups. The average post-operative stay in 5 cm transverse incision group was 2.6 days (range 1-4 days) and in the midline group was 4.0 days (range 3-5 days). There were 7 post-operative complications (all wound infections) in the 5 cm transverse group and 12 post-operative complications (10 wound infections and 2 pneumonitis) in the midline group. However, the difference in wound infection rate was not statistically significant (p > 0.1). In Conclusion, Cholecystectomy can be safely performed through a 5 cm transverse incision.
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PMID:Mini-lap cholecystectomy--an attractive alternative to conventional cholecystectomy. 797 54

A household survey of neonatal mortality was conducted during 1991 in Meerut District, about 70 km from Delhi in Uttar Pradesh, India. The sample included 2211 infants from 30 clusters, which included 111 deaths in the first year of life for data collected during November 12-19, 1991. The estimate of infant mortality rate was 50.1/1000 live births. There were 42 neonatal deaths--a neonatal rate of 19.0/1000 live births. 90.5% of neonates were home deliveries. 45.3% were delivered by an untrained birth attendant and 30.9% were delivered by a trained birth attendant. 11.9% were delivered by a family member. 42.8% of neonates who died did not receive treatment for an illness before their death. 11.9% of neonates, who died but received some treatment, were treated in hospitals. 66.7% of mothers had knowledge about prenatal immunization against tetanus, but only 30.9% received complete immunization, and 23.8% had one dose of tetanus toxoid vaccine. The most common causes of death were attributed to septicemia and neonatal tetanus infections (21.4% of neonatal deaths). Other causes of neonatal death were infantile diarrhea (11.9%), prematurity (9.5%), congenital anomalies (9.5%), pneumonia (7.2%), and birth asphyxia, meningitis, burn injury, and Rh incompatibility (2.4% each). This study in 1991 shows that neonatal mortality declined over the prior 10 years. However, outreach of qualified medical staff into this rural community was still limited. Knowledge of some health practices, such as immunization, was evident, but the service component was inadequate. This study confirms that exogenous factors contributed to at least 66% of neonatal deaths. These deaths could have been averted with proper and timely maternal and child health care services.
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PMID:Neonatal mortality in Meerut district. 811 86

During January 1989-September 1991, in India, neonatologists prescribed assisted ventilation (intermittent positive pressure ventilation [IPPV] and continuous positive airway pressure [CPAP]) for 90 neonates born and treated at a tertiary hospital in Delhi. All neonates requiring more than 168 hours of ventilation received IPPV. The smallest surviving neonate weighed 830 g at birth and was born at 26 weeks' gestation. This neonate received 510 hours of ventilation. One neonate received 48 days of ventilation (gestational age at birth, 28 weeks; birth weight, 800 g). This neonate eventually died due to necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), and sepsis. This infant was the only infant to develop NEC. A total of two newborns developed BPD. One infant developed retinopathy of prematurity (ROP). Indications for ventilation were hyaline membrane disease (HMD) (45/90), apnea (13/90), and transient tachypnea of the newborn (TTNB) (11/90). Almost all HMD cases who weighed more than 1.5 kg at birth on CPAP survived. CPAP successfully treated all TTNB cases. Nine neonates developed pneumothorax. Three of them survived. 34 neonates developed sepsis, the most common complication. 20 sepsis cases also had underlying pneumonia. Sepsis was responsible for 35% of deaths (14/40). Five infants on IPPV developed persistent pulmonary hypertension (persistent fetal circulation). 35 infants developed infection during ventilation, 34 of whom had a nosocomial infection. The nosocomial infection rate was 37.7%. Nosocomial infection was responsible for 35% of deaths. 12 babies (13%) developed pulmonary air leaks, 50% of whom died. 25 of the 33 infants on CPAP survived. Few CPAP cases developed pulmonary air leak, BPD, and ROP. Six of 22 very low birth weight (VLBW) infants (1 kg) survived. These findings led the researchers to recommend that medical centers with basic facilities for level II care should provide neonatal ventilation. They proposed that ventilation may not be cost effective for VLBW newborns, however.
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PMID:Three-year experience with neonatal ventilation from a tertiary care hospital in Delhi. 788 27

A prospective study was carried out on the incidence of pulmonary complications in 728 patients who underwent major surgical procedures at a reputed hospital in New Delhi. These patients were preoperatively assessed on the basis of history, clinical examination and bedside pulmonary function tests including PEFR, VC, FVC and FEV1. On the basis of these criteria, 212 patients had significant preoperative pulmonary disease, while 516 had normal lung functions. Postoperative pulmonary complications developed in 7.69 per cent of the patients. They were more frequent in smokers (P < 0.001) and in those with preoperative pulmonary dysfunction (P < 0.001). Their incidence was greater following thoraco-abdominal and musculoskeletal and miscellaneous operations compared to lower abdominal surgery (P < 0.001). The incidence was also higher following exposure to general anaesthesia compared to regional anaesthesia (P < 0.05). Pneumonia and atelectasis were the most common postoperative pulmonary complications. It was observed that the recovery of pulmonary functions was delayed in patients who developed postoperative pulmonary complications.
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PMID:Postoperative pulmonary complications in patients with preoperative lung disease. 834 31

In a prospective cohort study (1993-94) conducted at a tertiary care teaching hospital in New Delhi, India, the predictors of mortality in 201 children 2 weeks to 5 years of age admitted with acute lower respiratory infection (ALRI) were investigated. There were 21 deaths in this series, for a case fatality rate of 10.45%. Mortality was inversely associated with age. Multivariate logistic regression identified the following significant predictors of mortality: age less than 12 months (odds ratio (OR), 23.1), inability to feed (OR, 6.2), associated loose stools (OR, 5.1), weight-for-age Z score under 3 (OR, 3.9), short duration of fever (OR, 1.2), and bandemia (OR, 1.1). The clinical and investigative criteria set forth in the World Health Organization (WHO) guidelines successfully identified 91% of children with ALRI. The case fatality rate was related to the severity of the WHO classification: pneumonia, 0%; severe pneumonia, 8.7%; and very severe pneumonia, 47.0%. However, 2 of the 18 children without any pneumonia died. At present, children under 2 months of age are designated as high-risk ALRI cases and targeted for close monitoring, referral, and therapy. The finding of this study of a 23-fold increased risk of mortality in children under 12 months of age suggests this cut-off should be expanded to 12 months.
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PMID:Predictors of mortality in subjects hospitalized with acute lower respiratory tract infections. 928 88

The incidence and risk factors for neonatal nosocomial infection were investigated in a cohort study of 134 hospital-born infants transferred to a neonatal unit in New Delhi, India, after birth and observed for up to 72 hours. 22 of the 134 infants developed nosocomial infections. The median age at diagnosis was 184 hours. In 16 of these infants, both sepsis screen and blood culture were positive. Septicemia was diagnosed in 21 neonates; 11 had associated pneumonia and four had soft tissue infection. Multiresistant Klebsiella species was the infectious agent in 68% of cases. The overall nosocomial infection rate was 16.8/1000 patient-days and the device-associated infection rate was 11.9/1000 device-days. Factors significantly associated with neonatal nosocomial infection in the univariate analysis were low birth weight, prematurity, vaginal delivery, hyaline membrane disease, assisted ventilation, and use of peripheral venous and umbilical vascular catheters. In the final multivariate analysis, only birth weight under 1500 g (odds ratio, 3.3) and assisted ventilation for more than 72 hours (odds ratio, 14.2) remained significant risk factors. It was observed in 122 random observations in this hospital that 15-18% of nurses and residents failed to adhere to adequate hand-washing techniques. Strict adherence to aseptic protocols in neonatal units is essential to keep infection rates under control.
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PMID:Neonatal nosocomial infection: profile and risk factors. 933 94

The present prospective study was conducted at two urban slums of Delhi, Kusumpur Pahari and Kathputly Colony, in the peak winter season from November 1994 through February 1995. We studied 642 infants to determine the incidence of acute lower respiratory infection (ALRI) and its relationship to indoor air pollution due to fuel used for cooking (wood or kerosene). In Kusumpur Pahari, there were 317 children (142 wood and 175 kerosene), including 64 controls and 78 cases of ALRI in the wood fuel group and 81 controls and 94 ALRI cases in the kerosene group (p > 0.05). Out of 316 children in Kathputly Colony (174 wood and 142 kerosene), there were 33 and 45 ALRI cases in the wood and kerosene groups, respectively (p < 0.05). Controls were children without ALRI and were used as controls in different groups. The demographic data and risk factors, namely, nutritional and immunization status, were comparable in ALRI cases and controls in both study areas. Pneumonia was the most common ailment in all the groups. Bronchiolitis was reported in 22.5% of the wood group and 27.1% of the kerosene group in Kathputly Colony versus 13.7% in the wood group and 12.1% in the kerosene group in Kusumpur Colony. Only one case of croup was reported from Kusumpur Pahari among wood users. The duration of illness was longer in the Kusumpur Pahari due to poor compliance, feeding, and child rearing habits. In conclusion, a higher incidence of ALRI was reported in kerosene users in Kathputly Colony, a high pollution area; however, the reasons for the differences observed need further elucidation.
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PMID:Indoor air quality and acute lower respiratory infection in Indian urban slums. 956 Mar 55

We interviewed 113 private medical practitioners (PMPs) of all system of medicine in Ambedkar Nagar area of South Delhi to determine as to how they recognise and treat Acute Respiratory tract Infections (ARI) in children, in particular, pneumonia. Allopathic PMPs reported viruses and bacteria as causes of ARI as compared to PMPs of other system of medicine who often reported exposure to cold, change in weather and dietary habits as a cause of ARI. Sixty-eight PMPs out of 113 did not count the respiratory rate (RR) in children with ARI and among those who counted, only 19.5% PMPs could correctly tell the normal RR in children aged less than two months. In children aged 2-12 months, the percentage of PMPs responding correctly was 15.0%. Relatively greater proportion of PMPs (31.8%) could correctly tell the normal respiratory rate in children aged 1-5 years. X-ray to diagnose pneumonia was suggested by 102 (90.3%) PMPs. Majority of PMPs prescribed some form of medication including antibiotics for the treatment of cough and cold. Eighty-seven (77%) PMPs prescribed antibiotics, 53 (46.9%) antihistaminics and 49 (43.4%) prescribed allopathic cough syrups to treat cough and cold. For pneumonia, 108 (96.4%) PMPs prescribed antibiotics and 31 (27.7%) PMPs prescribed steroids among other things.
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PMID:Recognition and management of ARI--a KAP study on private medical practitioners. 1077 43


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